Arizona Licensed Behavioral Health Utilization Consultant

CVS Health; Maine; Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness programs

Bonus program

Job summary

CVS Health is seeking a clinician to coordinate and document utilization/benefit management for behavioral health, including child/adolescent care. You will apply medical necessity criteria, consult with internal and external stakeholders, and render coverage decisions along the care continuum.

The role requires 2+ years in behavioral health, an AZ license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW), and willingness to work 8am-5pm (AZ time) with up to 10% US travel.

Qualifications

• 2+ years of behavioral health experience.
• Active and good standing Arizona clinical license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW).
• Willingness to work Monday-Friday 8am-5pm (Arizona Time) and occasional weekends/holidays.
• Willingness to travel up to 10% within the United States.

Responsibilities

• Coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Apply clinical judgment to determine medical necessity criteria for utilization of services for child/adolescent members.
• Consult with internal and external stakeholders in utilization/benefit management.
• Gather clinical information and apply criteria to render coverage determinations/recommendations.
• Collaborate to evaluate and facilitate appropriate healthcare services/benefits for members, including urgent interventions.
• Coordinate with providers to facilitate optimal care/treatment.
• Identify members who may benefit from care management programs and facilitate referral.
• Identify opportunities to improve quality and effectiveness of healthcare services and benefit utilization.

Skills

Behavioral health experience

Active clinical license

Willingness to travel

Willingness to work 8am-5pm (Arizona)

Education

Masters-level clinician or RN license in AZ

Job description

CVS Health is seeking a clinician to coordinate and document utilization/benefit management for behavioral health, including child/adolescent care. You will apply medical necessity criteria, consult with internal and external stakeholders, and render coverage decisions along the care continuum.

The role requires 2+ years in behavioral health, an AZ license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW), and willingness to work 8am-5pm (AZ time) with up to 10% US travel.